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On behalf of myself (or my minor child), I hereby request an Ayurvedic consultation, body therapy or cooking class with an Ayurvedic Practitioner (AP) at Naivedya. I understand that my participation in this activity implies acceptance of the terms set forth:

• I understand that an AP is not a licensed physician, surgeon, medical or health care professional in the United States of America. Ayurveda is not a licensed practice in the State of California or Arizona and Ayurvedic treatment is alternative or complementary to healing art services licensed by the State of California.

• I fully understand that the sole purpose of a consultation is to assess the level of balance in my physiology using the principles of Ayurveda, and to make recommendations to enliven the body’s natural healing processes and restore balance. I understand that this assessment may be largely based on the information that I provide on a separate questionnaire and diet form. The regimen I may follow based on this consultation is not intended as a replacement for my primary medical care and treatment. I also understand that this consultation and any recommendations and health food supplements or herbs are not a substitute for medical examination, diagnosis and treatment. On the basis of this consultation with the AP, I will not modify or suspend any treatment program that I am receiving, without the prior knowledge and approval of my physician.

• I understand that it is not within the scope of this consultation for the AP to assume responsibility for the treatment of any specific health problems. The AP has made no claims or representations to the effect.

• I understand that I am fully responsible for the payment of the consultation fee. I understand that health insurance currently does not cover Ayurveda consultations.

• In consideration of participating in Naivedya’s cooking classes, I acknowledge and understand the dangers and risks inherent in such activities related to preparing food, consuming certain foods and working with tools and appliances. 

• I assume full responsibility for any injuries or damages resulting from my participation in this program including responsibility for using reasonable judgment in all phases of participation of the program.

• I acknowledge that my participation is solely at my own risk, and that I assume full responsibility for any resulting injuries and damages.

• I understand that it is my responsibility to notify the appropriate person in the workplace or event host(s) of emergency medical information and have informed the instructor of ANY food allergies/or dietary restrictions for myself.

• I have hereby read, understood, and I agree with the statements, terms and conditions above.

• I hereby waive, release, and discharge Naivedya, its instructors, officers, employees and volunteers from all liabilities arising from an Ayurvedic consultation, Ayurvedic body work or participation in cooking classes.